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Bui MH, Lee DY, Park SJ, Park KH. Real-World Treatment Intensity and Patterns in Patients With Myopic Choroidal Neovascularization: Common Data Model in Ophthalmology. J Korean Med Sci 2023; 38:e174. [PMID: 37309694 DOI: 10.3346/jkms.2023.38.e174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 02/24/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND A paucity of data addressing real-world treatment of myopic choroidal neovascularization (mCNV) in the era of anti-vascular endothelial growth factor (VEGF) drugs led us to investigate real-world treatment intensity and treatment patterns in patients with mCNV. METHODS This is a retrospective, observational study using the Observational Medical Outcomes Partnership-Common Data Model database of treatment-naïve patients with mCNV over the 18-year study period (2003-2020). Outcomes were treatment intensity (time trends of total/average number of prescriptions, mean number of prescriptions in the first year and the second year after initiating treatment, proportion of patients with no treatment in the second year) and treatment patterns (subsequent patterns of treatment according to the initial treatment). RESULTS Our final cohort included 94 patients with at-least 1-year observation period. Overall, 96.8% of patients received anti-VEGF drugs as first-line treatment, with most of injections from bevacizumab. The number of anti-VEGF injections in each calendar year showed an increasing trend over time; however, there was a drop in the mean number of injections in the second year compared to the first year from 2.09 to 0.47. About 77% of patients did not receive any treatment in their second year of treatment regardless of drugs. Most of patients (86.2%) followed non-switching monotherapy only and bevacizumab was the most popular choice either in the first-line (68.1%) or in the second-line (53.8%) of treatment. Aflibercept was increasingly used as the first-line treatment for patients with mCNV. CONCLUSION Anti-VEGF drugs have become the treatment of choice and second-line treatment for mCNV over the past decade. Anti-VEGF drugs are effective for the treatment of mCNV as the non-switching monotherapy is the main treatment regimen in most cases and the number of treatments decreases significantly in the second year of treatment.
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Affiliation(s)
- Manh-Hung Bui
- Department of Ophthalmology, College of Medicine, Seoul National University, Seoul, Korea
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Da Yun Lee
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang Jun Park
- Department of Ophthalmology, College of Medicine, Seoul National University, Seoul, Korea
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea.
| | - Kyu Hyung Park
- Department of Ophthalmology, College of Medicine, Seoul National University, Seoul, Korea
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea.
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Allegrini D, Raimondi R, Borgia A, Sorrentino T, Montesano G, Tsoutsanis P, Cancian G, Verma Y, De Rosa FP, Romano MR. Curcumin in Retinal Diseases: A Comprehensive Review from Bench to Bedside. Int J Mol Sci 2022; 23:ijms23073557. [PMID: 35408920 PMCID: PMC8998602 DOI: 10.3390/ijms23073557] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/20/2022] [Accepted: 03/22/2022] [Indexed: 02/04/2023] Open
Abstract
Recent evidence in basic science is leading to a growing interest in the possible role of curcumin in treating retinal diseases. Curcumin has been demonstrated to be able to modulate gene transcription and reduce ganglion cell apoptosis, downgrade VEGF, modulate glucose levels and decrease vascular dysfunction. So far, the use of curcumin has been limited by poor bioavailability; to overcome this issue, different types of carriers have been used. Multiple recent studies disclosed the efficacy of using curcumin in treating different retinal conditions. The aim of this review is to comprehensively review and discuss the role of curcumin in retinal diseases from bench to bedside.
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Affiliation(s)
- Davide Allegrini
- Eye Center, Humanitas Gavazzeni-Castelli, 24128 Bergamo, Italy; (D.A.); (P.T.); (M.R.R.)
- Department of Biomedical Sciences, Humanitas University, 20100 Milano, Italy; (A.B.); (T.S.); (G.C.); (Y.V.); (F.P.D.R.)
| | - Raffaele Raimondi
- Department of Biomedical Sciences, Humanitas University, 20100 Milano, Italy; (A.B.); (T.S.); (G.C.); (Y.V.); (F.P.D.R.)
- Correspondence:
| | - Alfredo Borgia
- Department of Biomedical Sciences, Humanitas University, 20100 Milano, Italy; (A.B.); (T.S.); (G.C.); (Y.V.); (F.P.D.R.)
| | - Tania Sorrentino
- Department of Biomedical Sciences, Humanitas University, 20100 Milano, Italy; (A.B.); (T.S.); (G.C.); (Y.V.); (F.P.D.R.)
| | - Giovanni Montesano
- Optometry and Visual Sciences Department, University of London, London WC1E 7HU, UK;
| | - Panos Tsoutsanis
- Eye Center, Humanitas Gavazzeni-Castelli, 24128 Bergamo, Italy; (D.A.); (P.T.); (M.R.R.)
| | - Giuseppe Cancian
- Department of Biomedical Sciences, Humanitas University, 20100 Milano, Italy; (A.B.); (T.S.); (G.C.); (Y.V.); (F.P.D.R.)
| | - Yash Verma
- Department of Biomedical Sciences, Humanitas University, 20100 Milano, Italy; (A.B.); (T.S.); (G.C.); (Y.V.); (F.P.D.R.)
| | - Francesco Paolo De Rosa
- Department of Biomedical Sciences, Humanitas University, 20100 Milano, Italy; (A.B.); (T.S.); (G.C.); (Y.V.); (F.P.D.R.)
| | - Mario R. Romano
- Eye Center, Humanitas Gavazzeni-Castelli, 24128 Bergamo, Italy; (D.A.); (P.T.); (M.R.R.)
- Department of Biomedical Sciences, Humanitas University, 20100 Milano, Italy; (A.B.); (T.S.); (G.C.); (Y.V.); (F.P.D.R.)
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Giorno P, Iacono P, Scarinci F, Di Renzo A, Varano M, Parravano M. Microvasculature Changes of Myopic Choroidal Neovascularization and the Predictive Value of Feeder Vessel Disappearance after Ranibizumab Treatment Revealed Using Optical Coherence Tomography Angiography. Ophthalmologica 2019; 243:263-270. [PMID: 31838464 DOI: 10.1159/000504755] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 11/13/2019] [Indexed: 11/19/2022]
Abstract
AIM To investigate vascular changes of myopic choroidal neovascularization (mCNV) after ranibizumab treatment using optical coherence tomography-angiography (OCTA). METHODS Consecutive subjects with a diagnosis of mCNV were included. Patients underwent intravitreal injection of ranibizumab treatment with a 6-month follow-up. All patients underwent a complete ophthalmological examination and OCTA evaluation. The 3 × 3 OCTA en face images were analyzed for the absence/presence of mCNV, CNV area, and CNV network morphology. In particular, the morphology of the mCNV was analyzed in order to detect the presence/absence of feeder vessels. RESULTS Eleven subjects were evaluated. At baseline, the mCNV was identified in all cases on OCTA. At 6 months, the mean mCNV area was not statically significantly reduced in comparison with baseline values (p > 0.05), while the morphologic analysis revealed a complete disappearance of the feeder vessel in 6 eyes. The subgroup analysis of these latter showed that the CNV area was significantly reduced, visual acuity had improved, and only one intravitreal injection was administrated over the entire follow-up period. CONCLUSIONS OCTA allowed the detection of qualitative and quantitative vascular changes in mCNV. The disappearance of the feeder vessel was associated with better anatomical as well as functional outcomes at the last follow-up visit.
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Karst SG, Schuster M, Mitsch C, Meyer EL, Kundi M, Scholda C, Schmidt‐Erfurth UM. Atrophy of the central neuroretina in patients treated for diabetic macular edema. Acta Ophthalmol 2019; 97:e1054-e1061. [PMID: 31228332 PMCID: PMC6900069 DOI: 10.1111/aos.14173] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 05/28/2019] [Indexed: 01/28/2023]
Abstract
Purpose To examine the prevalence of central retinal atrophy in patients treated for diabetic macular edema (DME) in a clinical setting. Methods Retrospective data analysis of patients with DME, focusing on those who developed central retinal thinning after DME treatment at the Department of Ophthalmology, Medical University Vienna. Patient characteristics and clinical data including best‐corrected visual acuity (BCVA), spectral domain optical coherence tomography and fluorescence angiography images were reviewed and DME treatment strategies analysed using descriptive statistics. The correlation between visual acuity and ocular, systemic or DME treatment factors was calculated using linear regression models and ancovas. Results A total of 6684 outpatient visits by 1437 patients with diabetes were analysed. Out of 149 patients, who had had a central subfield thickness (CST) below 200 μm, 32 (36 eyes) had previously been diagnosed with a centre involving DME with an average CST of 473 ± 103 μm and average visual acuity of 0.62 ± 0.44 logMAR at first presentation. At the time of central atrophy, 29 (81%) out of 36 eyes had a history of laser treatment, 11 (31%) a vitrectomy, 32 (88%) repeated intravitreal injections of anti‐vascular endothelial growth factor (VEGF; mean 5.3 ± 3.8) and 22 (61%) intravitreal corticosteroid injections (mean 2.5 ± 2.7). Visual function (0.67 ± 0.43 logMAR) at the time of atrophy was not significantly correlated to central retinal thickness (191 ± 7 μm) or any other ocular, systemic or treatment factors. Conclusions Only 4% of patients treated for DME developed central retinal thinning in our observation period. On average, our atrophy patients had higher CST and lower BCVA when they first presented with DME compared to the overall DME cohort, and they received a combination of intravitreal injections and laser for DME treatment. Central retinal atrophy might not be attributed to excessive use of intravitreally applied anti‐VEGF or any other DME therapy alone.
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Affiliation(s)
- Sonja G. Karst
- Department of Ophthalmology and Optometry Medical University Vienna Vienna Austria
| | - Magdalena Schuster
- Department of Ophthalmology and Optometry Medical University Vienna Vienna Austria
| | - Christoph Mitsch
- Department of Ophthalmology and Optometry Medical University Vienna Vienna Austria
| | - Elias L. Meyer
- Section for Medical Statistics Center for Medical Statistics, Informatics, and Intelligent Systems Medical University Vienna Vienna Austria
| | - Michael Kundi
- Institute of Environmental Health Medical University Vienna Vienna Austria
| | - Christoph Scholda
- Department of Ophthalmology and Optometry Medical University Vienna Vienna Austria
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Morgan-Warren PJ. Ophthalmic medicine regulatory approvals through the European Centralised Procedure, 1999-2017: Clinical efficacy considerations. Eur J Ophthalmol 2019; 30:321-349. [PMID: 30832499 DOI: 10.1177/1120672119830932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Regulatory approval of new medicines requires a thorough assessment of the potential clinical benefits and risks. Study end-points are expected to demonstrate a clinically relevant treatment effect that will translate into direct patient benefits. This study sought to review the ophthalmic medicines with European Union-wide approval granted via the Centralised Procedure and characterise the key efficacy end-points underpinning the demonstration of clinical benefit. METHODS This study was a retrospective review of published data pertaining to the European regulatory authorisation of centrally approved ophthalmic products between 1999 and 2017, inclusive. All sources and data consulted are in the public domain. European Public Assessment Reports published by the European Medicines Agency were consulted for data concerning the pivotal clinical efficacy studies supporting the applications. Data analyses were descriptive. RESULTS The European Medicines Agency have authorised 30 products via the Centralised Procedure between 1999 and 2017. For these products, a total of 24 additional approvals for line extensions or additional therapeutic indications were granted. Four products have been approved for orphan indications, including one approval 'under exceptional circumstances' and one 'Conditional Marketing Authorisation'. Approvals for products in retina (36%) and glaucoma (28%) indications together accounted for the majority of authorisations, with trial end-points predominantly based on visual acuity and intraocular pressure parameters, respectively. Products were also approved for indications in ocular surface disease, inflammation, optic neuropathy and surgical adjuncts, with a range of functional and anatomical end-points. CONCLUSION Approvals for ophthalmic medicines have been granted for a range of clinical indications, representing a considerable portion of available major therapeutics for practitioners. Benefit-risk assessments rely on clinical trial data demonstrating a clearly relevant patient benefit.
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McCarthy G, Fenu E, Bennett N, Almond C. Intravitreal Ranibizumab for the Treatment of Visual Impairment Due to Choroidal Neovascularization Associated with Rare Diseases: Cost-Effectiveness in the UK. Adv Ther 2019; 36:632-644. [PMID: 30726549 DOI: 10.1007/s12325-019-0894-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION This study sought to determine the cost-effectiveness of intravitreal ranibizumab compared with best supportive care (BSC; considered to be no active treatment) for the treatment of visual impairment due to choroidal neovascularization (CNV) associated with causes other than neovascular age-related macular degeneration (nAMD) and pathologic myopia (PM) in a UK setting. METHODS An individual patient-level simulation model was developed to estimate the lifetime costs and quality-adjusted life years (QALYs) of ranibizumab vs. BSC. Regression analyses, performed on patient-level data collected within the pivotal phase III MINERVA trial, modelled visual acuity (VA) progression while patients remained on treatment. Patient utilities were modelled as a function of VA in both eyes and resource use estimates were based on trial data or the literature. Costs were evaluated from the perspective of the UK National Health Service and personal social services, with future costs and health outcomes discounted at 3.5% per annum. Sensitivity and scenario analyses were conducted. RESULTS The incremental cost-effectiveness ratio for intravitreal ranibizumab was £1363 per QALY compared to BSC and was associated with an incremental benefit of 1.06 QALYs and an incremental cost of £1444 per patient. Drug and administration costs of intravitreal ranibizumab were offset by the prevention of the development of blindness and its associated costs, while the increase in benefits was driven by a reduction in mortality risk and an improved health-related quality of life attributed to an improvement in VA. The findings were robust to a range of sensitivity analyses and ranibizumab consistently remained cost-effective at a willingness-to-pay threshold of £20,000-30,000 per QALY gained for all sensitivity analyses. CONCLUSION Intravitreal ranibizumab is a highly cost-effective intervention for the treatment of CNV due to causes other than nAMD and PM as it delivers substantial QALY gains to patients while making cost savings vs. BSC. FUNDING Novartis Pharmaceuticals UK Ltd.
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Sahoo NK, Singh SR, Rajendran A, Shukla D, Chhablani J. Masqueraders of central serous chorioretinopathy. Surv Ophthalmol 2019; 64:30-44. [DOI: 10.1016/j.survophthal.2018.09.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 08/23/2018] [Accepted: 09/07/2018] [Indexed: 11/26/2022]
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Clinical Efficacy and Safety of Current Interventions for Choroidal Neovascularization Associated with Rare Diseases: A Systematic Literature Review. Adv Ther 2018; 35:591-603. [PMID: 29687336 DOI: 10.1007/s12325-018-0698-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The aim of this systematic literature review was to evaluate the efficacy and safety of interventions for the treatment of choroidal neovascularization (CNV) secondary to etiologies other than age-related macular degeneration and pathologic myopia. METHODS Relevant randomized controlled trials (RCTs) and prospective observational studies were identified by searching MEDLINE, MEDLINE In-Process, EMBASE, and CENTRAL. RESULTS The search identified 5 RCTs; no relevant observational studies were identified. The studies differed in terms of underlying cause of CNV, patient numbers (n = 9-178), follow-up time (2-36 months) and quality assessment. In the largest RCT (n = 178 across a range of rare CNV etiologies), intravitreal ranibizumab showed superior efficacy versus sham from baseline to month 2 [mean best-corrected visual acuity (BCVA): + 9.5 vs. - 0.4 letters; p < 0.001]; the gain was maintained up to month 12. In the treatment of CNV secondary to presumed ocular histoplasmosis syndrome (POHS), both intravitreal ranibizumab and photodynamic therapy (PDT) showed significant improvement from baseline BCVA over the 12-month period (n = 9); however, all patients in the PDT group required rescue ranibizumab therapy. Unlicensed intravitreal bevacizumab was associated with a statistically significant improvement in BCVA compared to PDT at 12 months (p < 0.001) in patients with CNV secondary to multifocal choroiditis (n = 27). The use of steroids before PDT showed better BCVA outcomes than PDT alone (p < 0.05) in patients with idiopathic CNV (n = 20). Argon green laser therapy showed limited efficacy in patients with CNV secondary to OHS (n = 134). CONCLUSION There is evidence from a relatively large, good-quality study to support the use of intravitreal ranibizumab for the treatment of CNV secondary to rare diseases. However, the limited number of RCTs for this indication and differences in study characteristics between RCTs mean that there is uncertainty regarding comparative clinical effectiveness of interventions. RCTs with an active comparator are required to fully establish the comparative effectiveness of treatments for CNV secondary to rare diseases. FUNDING Novartis Pharmaceuticals UK Ltd, Surrey, UK.
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Wozniak-Knopp G, Stadlmayr G, Perthold JW, Stadlbauer K, Woisetschläger M, Sun H, Rüker F. Designing Fcabs: well-expressed and stable high affinity antigen-binding Fc fragments. Protein Eng Des Sel 2017; 30:657-671. [DOI: 10.1093/protein/gzx042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 07/16/2017] [Indexed: 01/15/2023] Open
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Li Y, Zhu P, Verma A, Prasad T, Deng H, Yu D, Li Q. A novel bispecific molecule delivered by recombinant AAV2 suppresses ocular inflammation and choroidal neovascularization. J Cell Mol Med 2017; 21:1555-1571. [PMID: 28332318 PMCID: PMC5543459 DOI: 10.1111/jcmm.13086] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 12/13/2016] [Indexed: 02/05/2023] Open
Abstract
Elevated vascular endothelial growth factor (VEGF) and complement activation are implicated in the pathogenesis of different ocular diseases. The objective of this study was to investigate the hypothesis that dual inhibition of both VEGF and complement activation would confer better protection against ocular inflammation and neovascularization. In this study, we engineered a secreted chimeric VEGF inhibitor domain (VID), a complement inhibitor domain (CID) and a dual inhibitor (ACVP1). Vectors expressing these three inhibitors were constructed and packaged into AAV2 (sextY-F) particles. The expression and secretion of the proteins were validated by Western blot. The effects of these inhibitors expressed from AAV2 vectors were examined in endotoxin-induced uveitis (EIU), experimental autoimmune uveoretinitis (EAU) and choroidal neovascularization (CNV) mouse models. The AAV2 vectors expressing the CID- and ACVP1-attenuated inflammation in EIU and EAU model, whereas the vector expressing VID showed improved retinal structure damaged by EAU, but not affect the infiltration of inflammatory cells in EAU or EIU eyes. Both VID and CID vectors improved laser-induced retinal and choroid/RPE injuries and CNV, whereas ACVP1 vector provided significantly better protection. Our results suggest that gene therapy targeting VEGF and complement components could provide an innovative and long-term strategy for ocular inflammatory and neovascular diseases.
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Affiliation(s)
- Yiming Li
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, Sichuan, China.,Department of Ophthalmology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Ping Zhu
- Department of Ophthalmology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Amrisha Verma
- Department of Ophthalmology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Tuhina Prasad
- Department of Ophthalmology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Hongxin Deng
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, Sichuan, China
| | - Dechao Yu
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, Sichuan, China
| | - Qiuhong Li
- Department of Ophthalmology, College of Medicine, University of Florida, Gainesville, FL, USA
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Barth T, Zeman F, Helbig H, Gamulescu MA. Intravitreal anti-VEGF treatment for subretinal neovascularisation secondary to type 2 idiopathic juxtafoveolar telangiectasia. Int Ophthalmol 2017; 38:191-198. [PMID: 28108904 DOI: 10.1007/s10792-017-0447-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 01/05/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE To assess the long-term outcome of patients with subretinal neovascular membrane (SRNVM) secondary to type 2 idiopathic juxtafoveolar telangiectasia (IJT) receiving intravitreal anti-VEGF (vascular endothelial growth factor) injections. METHODS A total of 14 eyes of 12 patients treated with intravitreal anti-VEGF for SRNVM related to type 2 IJT were retrospectively assessed. RESULTS Nine men and 3 women with a mean age of 66 years (SD 12, range 47-87 years) were diagnosed with IJT-related SRNVM. On average, 6.8 injections (SD 5.5, range 3-18) were given per eye. Ten eyes were treated with ranibizumab, 3 eyes with bevacizumab and 1 eye received both substances. The median follow-up after the last injection was 31 months (IQR: 18, 48). In 6 eyes, BCVA improved by 1-4 lines (mean Δ +2.0 lines), 1 eye remained stable and 7 eyes showed decline of vision by 1-5 lines (mean Δ -2.1 lines). The baseline central foveal thickness was significantly reduced from a mean of 323 (SD 87) to 266 µm (SD 71 µm) at the last follow-up visit (p = 0.001). CONCLUSIONS SRNVM development is a severe complication of type 2 IJT. Since the establishment of intravitreal anti-VEGF treatment laser coagulation and PDT have lost significance. Intravitreal anti-VEGF therapy seems to be safe and effective for the treatment of IJT-related SRNVM. Frequently multiple intravitreal injections are necessary for stabilisation.
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Affiliation(s)
- Teresa Barth
- Department of Ophthalmology, University Medical Centre Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
| | - Florian Zeman
- Centre for Clinical Studies (ZKS), University Medical Centre Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Horst Helbig
- Department of Ophthalmology, University Medical Centre Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Maria-Andreea Gamulescu
- Department of Ophthalmology, University Medical Centre Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
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Liu B, Bao L, Zhang J. Optical Coherence Tomography Angiography Of Pathological Myopia Sourced and Idiopathic Choroidal Neovascularization With Follow-Up. Medicine (Baltimore) 2016; 95:e3264. [PMID: 27057880 PMCID: PMC4998796 DOI: 10.1097/md.0000000000003264] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
To observe optical coherence tomography angiography (OCTA) images during follow-up of choroidal neovascularization (CNV) caused by pathological myopia (PM) or idiopathy and discuss OCTA's clinical applicationsPatients with CNV caused by PM or idiopathic CNV (ICNV) were recruited prospectively from the Department of Ophthalmology, West China Hospital from March 2015 to June 2015. Intravitreal injections of Ranibizumab were conducted on all patients and repeated treatments were performed based on examinations of follow-up. Patients received OCTA the first week after injection, together with measurements of best-corrected visual acuity (BCVA) and central macular thickness (CMT). Subsequent follow-up was done once a month.About 10 eyes of 10 patients were included in this study and mean age was (46.20 ± 10.15) years old. Around 6 (60%) were females and the other 4 (40%) were males and 5 were diagnosed with PM and 5 were ICNV. Mean follow-up was (7.82 ± 2.47) weeks. Except 4 (40%) patients got only 1 injection, 5 (50%) received two injections, and 1 (10%) patient got 4 (once every two weeks) due to his treatment-resistant lesion. Endpoint date of this study was on 25th June, 2015. Mean baseline BCVA was (0.81 ± 0.45) logarithm of minimal angle resolution (logMAR) and increased significantly to (0.50 ± 0.40) at last follow-up (P = 0.005). Average CMT of baseline was (276.90 ± 69.73) um and decreased to (249.70 ± 53.37) um at final follow-up with the statistical significance (P = 0.008). OCTA demonstrated details of reduction of CNV size and vessel density simultaneously.OCTA could demonstrate the valid CNV form having advantages of rapid, noninvasive and repeatable. Combination of OCTA and other examinations had a promising future of clinical application on ocular neovascularization diseases. Further studies with larger sample size and longer follow-up are necessary and more advanced OCTA is being expected.
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Affiliation(s)
- Bing Liu
- From the Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, P.R. China
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Pharmacology of the retinal pigment epithelium, the interface between retina and body system. Eur J Pharmacol 2016; 787:84-93. [PMID: 27044435 DOI: 10.1016/j.ejphar.2016.03.066] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 03/14/2016] [Accepted: 03/31/2016] [Indexed: 12/12/2022]
Abstract
The retinal pigment epithelium (RPE) is a close, interactive partner to the photoreceptors as well as an interface with the endothelium of the choroid and thus with the body's circulatory system. To fulfill these roles, the RPE communicates with neighboring tissue by secretion of a large variety of factors and is able to react to secreted factors via a plethora of transmembrane receptors. Clinically relevant local pharmacological effects are caused by anti-VEGF-A treatment in choroidal neovascularization or by carboanhydrase inhibitors reducing fluid accumulation in the macula. Being exposed to the bloodstream, the RPE reacts to systemic disease, such as diabetes or hypertension, but also to systemic pharmacological intervention, for example to hypotensive drugs acting on the renin-angiotensin-system. Sustained pharmacological treatments, in particular, cause side effects at the RPE with consequences for both RPE function and photoreceptor survival. Among these are systemic inhibition of angiotensin-converting enzyme, insulin treatment in diabetes and anti-VEGF-A therapy. Given the special anatomical and functional relationships of the RPE, pharmacological intervention targeting either the eye or the body systemically should take potential alteration of RPE and subsequently photoreceptor function into account.
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Heymann HB, Colon D, Gill MK. Choroidal neovascularization secondary to tubulointerstitial nephritis and uveitis syndrome (TINU) in an adult patient. J Ophthalmic Inflamm Infect 2015; 5:29. [PMID: 26446047 PMCID: PMC4596145 DOI: 10.1186/s12348-015-0059-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 09/18/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inflammation is a well-known risk factor for the development of choroidal neovascularization (CNV), yet not all causes of intraocular inflammation have been documented to cause CNV. Tubulointerstitial nephritis and uveitis syndrome (TINU) is a rare cause of intraocular inflammation mostly in pediatric patients and only seldom has been associated with development of CNV. FINDINGS A 34-year-old pregnant female with a past history of bilateral ocular inflammation secondary to TINU presents 1 year after diagnosis with vision loss in the left eye. Clinical examination and investigations show the development of CNV in the left eye. The patient was treated with ranibizumab (Genentech, San Francisco, CA) intravitreal injections with improvement in symptoms and clinical findings. CONCLUSIONS We report the first case of CNV secondary to TINU in an adult patient. The CNV associated with TINU is responsive to intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy.
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Affiliation(s)
- Hans Barron Heymann
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, 645 N. Michigan Ave, Suite 440, Chicago, IL, 60611, USA
| | - Daniel Colon
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, 645 N. Michigan Ave, Suite 440, Chicago, IL, 60611, USA
| | - Manjot K Gill
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, 645 N. Michigan Ave, Suite 440, Chicago, IL, 60611, USA.
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